Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

triamcinolone Top 0.1% 15 gm Oint [VDMC]

Facility

$14.40

Service Code	HCPCS A9270
Hospital Charge Code	10426575
Hospital Revenue Code	259
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$12.96
Rate for Payer: Aetna of IA Commercial	$12.96
Rate for Payer: Aetna of IA Medical Rental Products	$12.96
Rate for Payer: Cash Price	$11.52
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.80
Rate for Payer: Medical Associates Commercial	$10.80
Rate for Payer: Midlands Choice Commercial	$10.08
Rate for Payer: United Healthcare Commercial	$12.96

triamcinolone Top 0.1% 15 gm Oint [VDMC]

Facility

$14.40

Service Code	HCPCS A9270
Hospital Charge Code	10426575
Hospital Revenue Code	259
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.96
Rate for Payer: Aetna of IA Commercial	$12.96
Rate for Payer: Aetna of IA Medical Rental Products	$12.96
Rate for Payer: Aetna of IA Medicare	$8.21
Rate for Payer: Amerigroup Medicaid	$8.31
Rate for Payer: Amerigroup Medicare	$6.54
Rate for Payer: Cash Price	$11.52
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.80
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.48
Rate for Payer: Iowa Total Care Managed Medicaid	$8.23
Rate for Payer: Medical Associates Commercial	$10.80
Rate for Payer: Medical Associates Managed Medicare	$6.48
Rate for Payer: Midlands Choice Commercial	$10.08
Rate for Payer: Molina Healthcare Managed Medicaid	$8.35
Rate for Payer: Partners Health Alliance Commercial	$7.45
Rate for Payer: United Healthcare Commercial	$12.96
Rate for Payer: United Healthcare Managed Medicare	$8.50

triamcinolone Top 0.1% 80 gm Crm [VDMC]

Facility

$17.84

Service Code	HCPCS A9270
Hospital Charge Code	10426445
Hospital Revenue Code	259
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$16.06
Rate for Payer: Aetna of IA Commercial	$16.06
Rate for Payer: Aetna of IA Medical Rental Products	$16.06
Rate for Payer: Aetna of IA Medicare	$10.17
Rate for Payer: Amerigroup Medicaid	$10.29
Rate for Payer: Amerigroup Medicare	$8.11
Rate for Payer: Cash Price	$14.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$13.38
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$8.03
Rate for Payer: Iowa Total Care Managed Medicaid	$10.19
Rate for Payer: Medical Associates Commercial	$13.38
Rate for Payer: Medical Associates Managed Medicare	$8.03
Rate for Payer: Midlands Choice Commercial	$12.49
Rate for Payer: Molina Healthcare Managed Medicaid	$10.34
Rate for Payer: Partners Health Alliance Commercial	$9.23
Rate for Payer: United Healthcare Commercial	$16.06
Rate for Payer: United Healthcare Managed Medicare	$10.53

triamcinolone Top 0.1% 80 gm Crm [VDMC]

Facility

$17.84

Service Code	HCPCS A9270
Hospital Charge Code	10426445
Hospital Revenue Code	259
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$16.06
Rate for Payer: Aetna of IA Commercial	$16.06
Rate for Payer: Aetna of IA Medical Rental Products	$16.06
Rate for Payer: Cash Price	$14.27
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$13.38
Rate for Payer: Medical Associates Commercial	$13.38
Rate for Payer: Midlands Choice Commercial	$12.49
Rate for Payer: United Healthcare Commercial	$16.06

triamcinolone Top 0.1% 80 gm Oint [VDMC]

Facility

$25.60

Service Code	HCPCS A9270
Hospital Charge Code	10426640
Hospital Revenue Code	259
Min. Negotiated Rate	$17.92
Max. Negotiated Rate	$23.04
Rate for Payer: Aetna of IA Commercial	$23.04
Rate for Payer: Aetna of IA Medical Rental Products	$23.04
Rate for Payer: Cash Price	$20.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.20
Rate for Payer: Medical Associates Commercial	$19.20
Rate for Payer: Midlands Choice Commercial	$17.92
Rate for Payer: United Healthcare Commercial	$23.04

triamcinolone Top 0.1% 80 gm Oint [VDMC]

Facility

$25.60

Service Code	HCPCS A9270
Hospital Charge Code	10426640
Hospital Revenue Code	259
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$23.04
Rate for Payer: Aetna of IA Commercial	$23.04
Rate for Payer: Aetna of IA Medical Rental Products	$23.04
Rate for Payer: Aetna of IA Medicare	$14.59
Rate for Payer: Amerigroup Medicaid	$14.77
Rate for Payer: Amerigroup Medicare	$11.64
Rate for Payer: Cash Price	$20.48
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.20
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.52
Rate for Payer: Iowa Total Care Managed Medicaid	$14.62
Rate for Payer: Medical Associates Commercial	$19.20
Rate for Payer: Medical Associates Managed Medicare	$11.52
Rate for Payer: Midlands Choice Commercial	$17.92
Rate for Payer: Molina Healthcare Managed Medicaid	$14.84
Rate for Payer: Partners Health Alliance Commercial	$13.25
Rate for Payer: United Healthcare Commercial	$23.04
Rate for Payer: United Healthcare Managed Medicare	$15.10

triamcinolone topical 0.1% Pas [VDMC]

Facility

$60.64

Service Code	HCPCS A9270
Hospital Charge Code	11223022
Hospital Revenue Code	259
Min. Negotiated Rate	$42.45
Max. Negotiated Rate	$54.58
Rate for Payer: Aetna of IA Commercial	$54.58
Rate for Payer: Aetna of IA Medical Rental Products	$54.58
Rate for Payer: Cash Price	$48.51
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.48
Rate for Payer: Medical Associates Commercial	$45.48
Rate for Payer: Midlands Choice Commercial	$42.45
Rate for Payer: United Healthcare Commercial	$54.58

triamcinolone topical 0.1% Pas [VDMC]

Facility

$60.64

Service Code	HCPCS A9270
Hospital Charge Code	11223022
Hospital Revenue Code	259
Min. Negotiated Rate	$27.29
Max. Negotiated Rate	$54.58
Rate for Payer: Aetna of IA Commercial	$54.58
Rate for Payer: Aetna of IA Medical Rental Products	$54.58
Rate for Payer: Aetna of IA Medicare	$34.56
Rate for Payer: Amerigroup Medicaid	$34.98
Rate for Payer: Amerigroup Medicare	$27.56
Rate for Payer: Cash Price	$48.51
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$45.48
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.29
Rate for Payer: Iowa Total Care Managed Medicaid	$34.64
Rate for Payer: Medical Associates Commercial	$45.48
Rate for Payer: Medical Associates Managed Medicare	$27.29
Rate for Payer: Midlands Choice Commercial	$42.45
Rate for Payer: Molina Healthcare Managed Medicaid	$35.15
Rate for Payer: Partners Health Alliance Commercial	$31.38
Rate for Payer: United Healthcare Commercial	$54.58
Rate for Payer: United Healthcare Managed Medicare	$35.78

triamterene-hydrochlorothiazide 37.5-25 mg Cap [VDMC]

Facility

$1.44

Service Code	HCPCS A9270
Hospital Charge Code	10394181
Hospital Revenue Code	259
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.29
Rate for Payer: Aetna of IA Commercial	$1.29
Rate for Payer: Aetna of IA Medical Rental Products	$1.29
Rate for Payer: Aetna of IA Medicare	$0.82
Rate for Payer: Amerigroup Medicaid	$0.83
Rate for Payer: Amerigroup Medicare	$0.65
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.08
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.65
Rate for Payer: Iowa Total Care Managed Medicaid	$0.82
Rate for Payer: Medical Associates Commercial	$1.08
Rate for Payer: Medical Associates Managed Medicare	$0.65
Rate for Payer: Midlands Choice Commercial	$1.01
Rate for Payer: Molina Healthcare Managed Medicaid	$0.83
Rate for Payer: Partners Health Alliance Commercial	$0.74
Rate for Payer: United Healthcare Commercial	$1.29
Rate for Payer: United Healthcare Managed Medicare	$0.85

triamterene-hydrochlorothiazide 37.5-25 mg Cap [VDMC]

Facility

$1.44

Service Code	HCPCS A9270
Hospital Charge Code	10394181
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.29
Rate for Payer: Aetna of IA Commercial	$1.29
Rate for Payer: Aetna of IA Medical Rental Products	$1.29
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.08
Rate for Payer: Medical Associates Commercial	$1.08
Rate for Payer: Midlands Choice Commercial	$1.01
Rate for Payer: United Healthcare Commercial	$1.29

Trichomonas vaginalis RNA (Female Only) DMCL

Facility

$100.00

Service Code	CPT 87661
Hospital Charge Code	8822402
Hospital Revenue Code	306
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: United Healthcare Commercial	$90.00

Trichomonas vaginalis RNA (Female Only) DMCL

Facility

$100.00

Service Code	CPT 87661
Hospital Charge Code	8822402
Hospital Revenue Code	306
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of IA Commercial	$90.00
Rate for Payer: Aetna of IA Medical Rental Products	$90.00
Rate for Payer: Aetna of IA Medicare	$57.00
Rate for Payer: Amerigroup Medicaid	$57.68
Rate for Payer: Amerigroup Medicare	$45.45
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$75.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$45.00
Rate for Payer: Iowa Total Care Managed Medicaid	$57.12
Rate for Payer: Medical Associates Commercial	$75.00
Rate for Payer: Medical Associates Managed Medicare	$45.00
Rate for Payer: Midlands Choice Commercial	$70.00
Rate for Payer: Molina Healthcare Managed Medicaid	$57.96
Rate for Payer: Partners Health Alliance Commercial	$51.75
Rate for Payer: United Healthcare Commercial	$90.00
Rate for Payer: United Healthcare Managed Medicare	$59.00

TRIGEMINAL NERVE BLOCK

Professional

Both

$325.00

Service Code	CPT 64400
Hospital Charge Code	8300882
Hospital Revenue Code	981
Min. Negotiated Rate	$158.75
Max. Negotiated Rate	$243.75
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Medical Associates Commercial	$243.75
Rate for Payer: Midlands Choice Commercial	$227.50
Rate for Payer: Partners Health Alliance Commercial	$243.75
Rate for Payer: United Healthcare Commercial	$158.75

TRIGEMINAL NERVE BLOCK - VDMC

Facility

$652.00

Service Code	CPT 64400
Hospital Charge Code	8300885
Hospital Revenue Code	450
Min. Negotiated Rate	$456.40
Max. Negotiated Rate	$586.80
Rate for Payer: Aetna of IA Commercial	$586.80
Rate for Payer: Aetna of IA Medical Rental Products	$586.80
Rate for Payer: Cash Price	$521.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$489.00
Rate for Payer: Medical Associates Commercial	$489.00
Rate for Payer: Midlands Choice Commercial	$456.40
Rate for Payer: United Healthcare Commercial	$586.80

TRIGEMINAL NERVE BLOCK - VDMC

Facility

$652.00

Service Code	CPT 64400
Hospital Charge Code	8300885
Hospital Revenue Code	450
Min. Negotiated Rate	$293.40
Max. Negotiated Rate	$586.80
Rate for Payer: Aetna of IA Commercial	$586.80
Rate for Payer: Aetna of IA Medical Rental Products	$586.80
Rate for Payer: Aetna of IA Medicare	$371.64
Rate for Payer: Amerigroup Medicaid	$376.07
Rate for Payer: Amerigroup Medicare	$296.33
Rate for Payer: Cash Price	$521.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$489.00
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$293.40
Rate for Payer: Iowa Total Care Managed Medicaid	$372.42
Rate for Payer: Medical Associates Commercial	$489.00
Rate for Payer: Medical Associates Managed Medicare	$293.40
Rate for Payer: Midlands Choice Commercial	$456.40
Rate for Payer: Molina Healthcare Managed Medicaid	$377.90
Rate for Payer: Partners Health Alliance Commercial	$337.41
Rate for Payer: United Healthcare Commercial	$586.80
Rate for Payer: United Healthcare Managed Medicare	$384.68

TRIGLYCERIDE

Facility

$55.00

Service Code	CPT 84478
Hospital Charge Code	633852
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Aetna of IA Medicare	$31.35
Rate for Payer: Amerigroup Medicaid	$31.72
Rate for Payer: Amerigroup Medicare	$25.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$24.75
Rate for Payer: Iowa Total Care Managed Medicaid	$31.42
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Medical Associates Managed Medicare	$24.75
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: Molina Healthcare Managed Medicaid	$31.88
Rate for Payer: Partners Health Alliance Commercial	$28.46
Rate for Payer: United Healthcare Commercial	$49.50
Rate for Payer: United Healthcare Managed Medicare	$32.45

TRIGLYCERIDE

Facility

$55.00

Service Code	CPT 84478
Hospital Charge Code	633852
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of IA Commercial	$49.50
Rate for Payer: Aetna of IA Medical Rental Products	$49.50
Rate for Payer: Cash Price	$44.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.25
Rate for Payer: Medical Associates Commercial	$41.25
Rate for Payer: Midlands Choice Commercial	$38.50
Rate for Payer: United Healthcare Commercial	$49.50

trihexyphenidyl 2 mg Tab [VDMC]

Facility

$1.15

Service Code	HCPCS A9270
Hospital Charge Code	10426705
Hospital Revenue Code	259
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.03
Rate for Payer: Aetna of IA Commercial	$1.03
Rate for Payer: Aetna of IA Medical Rental Products	$1.03
Rate for Payer: Aetna of IA Medicare	$0.65
Rate for Payer: Amerigroup Medicaid	$0.66
Rate for Payer: Amerigroup Medicare	$0.52
Rate for Payer: Cash Price	$0.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.86
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.52
Rate for Payer: Iowa Total Care Managed Medicaid	$0.65
Rate for Payer: Medical Associates Commercial	$0.86
Rate for Payer: Medical Associates Managed Medicare	$0.52
Rate for Payer: Midlands Choice Commercial	$0.80
Rate for Payer: Molina Healthcare Managed Medicaid	$0.66
Rate for Payer: Partners Health Alliance Commercial	$0.59
Rate for Payer: United Healthcare Commercial	$1.03
Rate for Payer: United Healthcare Managed Medicare	$0.68

trihexyphenidyl 2 mg Tab [VDMC]

Facility

$1.15

Service Code	HCPCS A9270
Hospital Charge Code	10426705
Hospital Revenue Code	259
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.03
Rate for Payer: Aetna of IA Commercial	$1.03
Rate for Payer: Aetna of IA Medical Rental Products	$1.03
Rate for Payer: Cash Price	$0.92
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.86
Rate for Payer: Medical Associates Commercial	$0.86
Rate for Payer: Midlands Choice Commercial	$0.80
Rate for Payer: United Healthcare Commercial	$1.03

trolamine salicylate Top 10% Crm [VDMC]

Facility

$14.00

Service Code	HCPCS A9270
Hospital Charge Code	10439776
Hospital Revenue Code	259
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of IA Commercial	$12.60
Rate for Payer: Aetna of IA Medical Rental Products	$12.60
Rate for Payer: Cash Price	$11.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.50
Rate for Payer: Medical Associates Commercial	$10.50
Rate for Payer: Midlands Choice Commercial	$9.80
Rate for Payer: United Healthcare Commercial	$12.60

trolamine salicylate Top 10% Crm [VDMC]

Facility

$14.00

Service Code	HCPCS A9270
Hospital Charge Code	10439776
Hospital Revenue Code	259
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of IA Commercial	$12.60
Rate for Payer: Aetna of IA Medical Rental Products	$12.60
Rate for Payer: Aetna of IA Medicare	$7.98
Rate for Payer: Amerigroup Medicaid	$8.07
Rate for Payer: Amerigroup Medicare	$6.36
Rate for Payer: Cash Price	$11.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$10.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$6.30
Rate for Payer: Iowa Total Care Managed Medicaid	$7.99
Rate for Payer: Medical Associates Commercial	$10.50
Rate for Payer: Medical Associates Managed Medicare	$6.30
Rate for Payer: Midlands Choice Commercial	$9.80
Rate for Payer: Molina Healthcare Managed Medicaid	$8.11
Rate for Payer: Partners Health Alliance Commercial	$7.24
Rate for Payer: United Healthcare Commercial	$12.60
Rate for Payer: United Healthcare Managed Medicare	$8.26

tropicamide Ophth 1% Sol 15ml [VDMC]

Facility

$36.16

Service Code	HCPCS A9270
Hospital Charge Code	10439841
Hospital Revenue Code	259
Min. Negotiated Rate	$25.31
Max. Negotiated Rate	$32.54
Rate for Payer: Aetna of IA Commercial	$32.54
Rate for Payer: Aetna of IA Medical Rental Products	$32.54
Rate for Payer: Cash Price	$28.93
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.12
Rate for Payer: Medical Associates Commercial	$27.12
Rate for Payer: Midlands Choice Commercial	$25.31
Rate for Payer: United Healthcare Commercial	$32.54

tropicamide Ophth 1% Sol 15ml [VDMC]

Facility

$36.16

Service Code	HCPCS A9270
Hospital Charge Code	10439841
Hospital Revenue Code	259
Min. Negotiated Rate	$16.27
Max. Negotiated Rate	$32.54
Rate for Payer: Aetna of IA Commercial	$32.54
Rate for Payer: Aetna of IA Medical Rental Products	$32.54
Rate for Payer: Aetna of IA Medicare	$20.61
Rate for Payer: Amerigroup Medicaid	$20.86
Rate for Payer: Amerigroup Medicare	$16.43
Rate for Payer: Cash Price	$28.93
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$27.12
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$16.27
Rate for Payer: Iowa Total Care Managed Medicaid	$20.65
Rate for Payer: Medical Associates Commercial	$27.12
Rate for Payer: Medical Associates Managed Medicare	$16.27
Rate for Payer: Midlands Choice Commercial	$25.31
Rate for Payer: Molina Healthcare Managed Medicaid	$20.96
Rate for Payer: Partners Health Alliance Commercial	$18.71
Rate for Payer: United Healthcare Commercial	$32.54
Rate for Payer: United Healthcare Managed Medicare	$21.33

TROPONIN

Facility

$162.00

Service Code	CPT 84484
Hospital Charge Code	1634892
Hospital Revenue Code	301
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$145.80
Rate for Payer: Aetna of IA Commercial	$145.80
Rate for Payer: Aetna of IA Medical Rental Products	$145.80
Rate for Payer: Cash Price	$129.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$121.50
Rate for Payer: Medical Associates Commercial	$121.50
Rate for Payer: Midlands Choice Commercial	$113.40
Rate for Payer: United Healthcare Commercial	$145.80

TROPONIN

Facility

$162.00

Service Code	CPT 84484
Hospital Charge Code	1634892
Hospital Revenue Code	301
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$145.80
Rate for Payer: Aetna of IA Commercial	$145.80
Rate for Payer: Aetna of IA Medical Rental Products	$145.80
Rate for Payer: Aetna of IA Medicare	$92.34
Rate for Payer: Amerigroup Medicaid	$93.44
Rate for Payer: Amerigroup Medicare	$73.63
Rate for Payer: Cash Price	$129.60
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$121.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$72.90
Rate for Payer: Iowa Total Care Managed Medicaid	$92.53
Rate for Payer: Medical Associates Commercial	$121.50
Rate for Payer: Medical Associates Managed Medicare	$72.90
Rate for Payer: Midlands Choice Commercial	$113.40
Rate for Payer: Molina Healthcare Managed Medicaid	$93.90
Rate for Payer: Partners Health Alliance Commercial	$83.83
Rate for Payer: United Healthcare Commercial	$145.80
Rate for Payer: United Healthcare Managed Medicare	$95.58

Know your out-of-pocket cost for care.

All Charges